AVP, Enterprise Quality Assurance & Accreditation

Job Summary:

The Associate Vice President, Enterprise Quality Assurance & Accreditation is responsible for providing strategic leadership and oversight of the accreditation program. They will ensure accreditation readiness and compliance to standards for various accreditation programs, effectively maintaining accreditation status. This role will also be responsible for managing relationships with executive leaders of accrediting bodies, such as NCQA and URAC.  

Essential Functions:

• Oversees and provides strategic leadership to the CareSource Accreditation Program, including Corporate and Market survey schedules and outcomes
• Oversees continuous accreditation readiness activities, audits, corrective actions and reporting, ensuring accurate and integrated completion of annual quality assessments (AQAs)
• Oversees specialty accreditations such as LTSS Distinction, Health Equity Accreditation, UM accreditation and others determined by company strategic goals
• Supports Mergers and Acquisitions to assure all ASA and delegated arrangements are in compliance with NCQA Mergers and Acquisition (MAC) policies
• Develops strategic plan for accreditation program, including planning for future accreditations
• Works collaboratively with key stakeholders across the business to mitigate identified deficiencies to ensure compliance to accreditation standards
• Identifies emerging best practices and people/process/technology solutions that drive improvement in quality indicators and accreditation program activities
• Accountable for development and implementation of QI policies and procedures in alignment with CMS, state regulatory and NCQA requirements. 
• Ensures oversight, measurement and accurate reporting of continuous survey readiness indicators, and timely/accurate compliance to internal and external reporting requirements
• Works closely with analytics teams to develop and optimize monitoring and reporting
• Responsible for fiscal planning and budgeting for assigned areas
• Supports functions of the CareSource Quality Executive Committee ensuring necessary preparation, participation, effectiveness, value and alignment of Committee activities and outputs with regulatory standards
• Develops and maintains relationships with key internal and external stakeholders, including executives of accrediting bodies, with strong ability to influence
• Prepare and deliver concise reports with key outputs and remediation plans for the executive team
• Perform any other job duties as requested

Education and Experience:

• Bachelor of Science degree in related field or equivalent years of relevant work experience is required
• Master’s degree is preferred
• Minimum of ten (10) years of quality improvement in the healthcare or managed care industry is required
• Experience with health plan and specialty accreditations, such as LTSS distinction and/or Health Equity is required
• Experience working with a national health plan with multifaceted business arrangements and structures preferred
• Minimum of five (5) years of leadership and management experience in managed care setting is required

Competencies, Knowledge and Skills:

• Strong strategic leadership/management skills
• Ability to be innovative and resourceful in problem resolution
• Ability to work collaboratively with all levels of management
• Ability to manage multiple complex priorities within a changing environment
• Strong verbal, written and presentation/communication skills
• Strong clinical/operational leadership experience/skills
• Proficient in Microsoft Word, Excel and PowerPoint
• Proven success in developing and implementing new practices and controls (with specific improvements)
• Detailed, in-depth knowledge of the principles of performance improvement, quality methodology, regulations and standards to meet health plan quality and accreditation requirements
• Working knowledge of health plan policies and procedures
• Strong analytical and statistical skills and attention to detail
• Present pertinent data and recommendations clearly and concisely in a manner appropriate to end user audience(s)
• Ability to develop, prioritize and accomplish goals
• Strong interpersonal skills and high level of professionalism
• Effective active listening and critical thinking skills
• Display a customer service, member-focused orientation

Licensure and Certification:

• Current, unrestricted nursing license is preferred
• CPHQ is preferred
• Six Sigma Black Belt or other Process Improvement Certification preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• This role may require up to 20% travel based on the needs of the department

Compensation range $150,000-$300,000.  CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Energize and Inspire the Organization

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.